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Machine Perfusion of Donor Livers for Transplantation: a Proposal for Standardized Nomenclature and Reporting Guidelines

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Machine Perfusion of Donor Livers for Transplantation: a Proposal for Standardized Nomenclature and Reporting Guidelines Machine Perfusion of Donor Livers for Transplantation: A Proposal for Standardized Nomenclature and Reporting Guidelines The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Karangwa, S. A., P. Dutkowski, P. Fontes, P. J. Friend, J. V. Guarrera, J. F. Markmann, H. Mergental, et al. 2016. “Machine Perfusion of Donor Livers for Transplantation: A Proposal for Standardized Nomenclature and Reporting Guidelines.” American Journal of Transplantation 16 (10): 2932-2942. doi:10.1111/ajt.13843. http:// dx.doi.org/10.1111/ajt.13843. Published Version doi:10.1111/ajt.13843 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:29738961 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA American Journal of Transplantation 2016; 16: 2932–2942 © 2016 The Authors. American Journal of Transplantation published by Wiley Periodicals Inc. Wiley Periodicals, Inc. on behalf of American Society of Transplant Surgeons doi: 10.1111/ajt.13843 Machine Perfusion of Donor Livers for Transplantation: A Proposal for Standardized Nomenclature and Reporting Guidelines S. A. Karangwa1,2, P. Dutkowski3, P. Fontes4,5, With increasing demand for donor organs for trans- P. J. Friend6, J. V. Guarrera7, J. F. Markmann8, plantation, machine perfusion (MP) promises to be a beneficial alternative preservation method for donor H. Mergental9, T. Minor10, C. Quintini11, 12 13 14 livers, particularly those considered to be of subopti- M. Selzner , K. Uygun , C. J. Watson mal quality, also known as extended criteria donor and R. J. Porte1,* livers. Over the last decade, numerous studies researching MP of donor livers have been published 1Section of Hepatobiliary Surgery and Liver and incredible advances have been made in both Transplantation, Department of Surgery, University of experimental and clinical research in this area. With Groningen, University Medical Center Groningen, numerous research groups working on MP, various Groningen, the Netherlands techniques are being explored, often applying differ- 2Surgical Research Laboratory, University of Groningen, ent nomenclature. The objective of this review is to University Medical Center Groningen, Groningen, the catalog the differences observed in the nomenclature Netherlands used in the current literature to denote various MP 3Department of Surgery & Transplantation, University techniques and the manner in which methodology is Hospital Zurich, Zurich, Switzerland reported. From this analysis, we propose a standard- 4Thomas E. Starzl Transplantation Institute Department ization of nomenclature on liver MP to maximize of Surgery, University of Pittsburgh Medical Center, consistency and to enable reliable comparison and Pittsburgh, PA meta-analyses of studies. In addition, we propose a 5McGowan Institute of Regenerative Medicine, standardized set of guidelines for reporting the University of Pittsburgh, Pittsburgh, PA methodology of future studies on liver MP that will 6Nuffield Department of Surgery, Oxford Transplant Centre, facilitate comparison as well as clinical implementa- University of Oxford, Churchill Hospital, Oxford, UK tion of liver MP procedures. 7Department of Surgery, Center for Liver Disease and Transplantation, Columbia University Medical Center, Abbreviations: MP, machine perfusion; PRISMA, New York, NY Preferred Reporting Items for Systematic Reviews 8Transplant Center, Massachusetts General Hospital, and Meta-Analyses; SCS, static cold storage Boston, MA 9Liver Unit, University Hospital Birmingham, Birmingham, UK Received 15 February 2016, revised 28 March 2016 10Department of Surgical Research, Clinic for General and accepted for publication 19 April 2016 Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany 11Department of Surgery, Transplant Center, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, 12Department of Surgery, Multi Organ Transplant Introduction Program, Toronto General Hospital, Toronto, ON, Canada 13Department of Surgery, Center for Engineering in In an effort to meet the demand for donor organs needed Medicine, Massachusetts General Hospital, Harvard for transplantation, livers considered to be of suboptimal Medical School, Boston, MA quality and function are increasingly being transplanted. 14University of Cambridge Department of Surgery and Given the increased vulnerability of these organs and the the NIHR Blood and Transplant Research Unit in Organ potential injury incurred during procurement and storage/ Donation and Transplantation University of Cambridge, transportation, machine perfusion (MP) is a promising Addenbrooke’s Hospital, Cambridge, UK alternative to static cold storage (SCS), the current stan- *Corresponding author: Robert J. Porte, [email protected] dard of care in donor liver preservation. Following the first successful series of extra-corporeally perfused canine liver This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs grafts performed by Brettschneider and Starzl et al. in License, which permits use and distribution in any 1967 (1), MP has been explored as a method to achieve medium, provided the original work is properly cited, the the preservation of donor livers under conditions simulat- use is non-commercial and no modifications or ing normal in vivo physiology in an attempt to minimize adaptations are made. ischemia-related injury associated with SCS. Research into 2932 Standardization of Nomenclature and Reporting of Liver Machine Perfusion MP has established three major benefits: the capability to was conducted using the medical subject heading (MeSH) terms and preserve donor organs while providing them with oxygen Emtree keywords “machine perfusion, machine preservation, liver and nutrients at various temperatures (optimal and pro- transplantation, and hepatic transplantation” combined with free text longed preservation); the ability to recondition and opti- terms regarding machine perfusion of donor livers such as “hypothermic,” “normothermic,” and “subnormothermic.” mize the function of donor organs, particularly extended criteria organs, with, for instance, oxygen perfsufflation, Selection criteria and data collection de-fatting techniques for steatotic livers and pharmaceuti- Study selection was performed independently by two authors (S.A.K and cal intervention (organ resuscitation and function recov- R.J.P.) in a standardized fashion using the Preferred Reporting Items for ery); and lastly, to provide the possibility of testing the Systematic Reviews and Meta-Analyses (PRISMA) method (2). Study function and viability of the organ prior to transplantation inclusion was carried out in three phases. An initial title search was car- (ex situ viability testing) by MP at 37°C. ried out whereby relevant titles were screened and studies whose titles were unrelated to the aims of this review were excluded. The abstracts With the number of publications on liver MP to date of the remaining studies were then acquired and independently assessed exceeding 500, the last 10 years has seen an incredible for eligibility. Full papers of the abstracts regarded as potentially eligible advancement in both experimental and clinical research were retrieved and underwent complete review and assessment until a final compilation of articles was made. For articles in which an inconsis- into donor liver MP. Several groups have been exploring tency between the two authors occurred, a discussion about these arti- different methods of MP with the major technique differ- cles was held to reach to a consensus. Figure 1 illustrates the study ences relating to the temperatures used and the provision selection procedure and the inclusion and exclusion criteria. of oxygen and whether the technique is flow or pressure controlled. Given that MP is a nascent technology with Inclusion criteria: many technical aspects continuing to be explored, adapted and improved, the publications on MP have exhibited great • All articles on machine perfusion of donor livers discrepancies. These include the nomenclature used to • Fully accessible articles written in English and published in scientific describe the different MP techniques (abbreviations journals • included), the temperatures considered to be hypo-, sub- Human and animal studies normo, or normothermic and the manner in which certain details of the methodology are reported. The absence of standardized nomenclature and guidelines for reporting Article titles identified in technical details pertaining to MP gives rise to the rela- all databases n= 2265 tively large variation that exists among studies. This makes it difficult to compare different studies, perform meta-ana- Irrelevant titles lyses and, in some cases, attempt to reexecute the excluded n= 1406 methodology used. With the number of clinical studies on MP of donor liv- Abstracts ers rapidly increasing, it is important that a consensus n= 859 is reached on the nomenclature applied and which nec- essary aspects of the methodology should be included Duplicates excluded n= 287 in a paper. The objective of this review is to catalog the Irrelevant abstracts excluded n= differences observed in the nomenclature used in the 291 current literature to denote various techniques of liver Unfound full articles
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